title: Reoperative intervention in patients with mesh at the hiatus is associated with high incidence of esophageal resection--a single-center experience.
abstract: BACKGROUND
  Mesh hiatoplasty is a widely debated topic among foregut surgeons. While short-term outcomes tout decreased recurrence rates, an increase in mesh-related complications has been reported. The aim of this study is to present a single-center experience with reoperative intervention in patients with previous mesh at the hiatus.
  
  
  METHODS
  After institutional review board approval, a prospectively maintained database was retrospectively queried to identify patients who underwent reoperative intervention between 2003 and spring of 2013 and had mesh placed at a previous hiatal hernia procedure. Patient charts were reviewed and data variables collected.
  
  
  RESULTS
  Twenty-six patients (mean age of 56.7 ± 18.3; 19 females) who underwent 27 procedures met the inclusion criteria. Synthetic mesh was placed in 15 (56 %) procedures, while the remaining 12 had biologic mesh. The mean interval between reoperative intervention and previous surgery was 33 months. Dysphagia (56 %) was the most common presentation, while three patients had mesh erosion. Recurrent hiatus hernia (2 to 7 cm) was noted in 19 (70 %) patients. Eight patients (30 %) underwent redo fundoplication, six patients (22 %) were converted to Roux-en-Y gastrojejunostomy, two patients (7.4 %) underwent distal esophagectomy with esophagojejunostomy, five patients (19 %) had subtotal esophagectomy with gastric pull-up, and one patient underwent substernal gastric pull-up for esophageal bypass with interval esophagectomy. The mean operative time was 252 ± 71.7 min, and the median blood loss was 150 ml (range, 50-1,650 ml). There was no postoperative mortality.
  
  
  CONCLUSIONS
  Reoperative intervention in patients with mesh at the hiatus is associated with a high need for esophageal resection. More than two thirds of the patients also had a recurrent hiatal hernia.
authors.affiliation: The Esophageal Center, Department of Surgery, Creighton University School of Medicine, Creighton University Medical Center, 601 North 30th Street, Suite 3700, Omaha, NE, 68131, USA.
authors.forename: Kalyana
authors.initials: K
authors.lastname: Nandipati
authors.forename: Maria
authors.initials: M
authors.lastname: Bye
authors.forename: Se Ryung
authors.initials: SR
authors.lastname: Yamamoto
authors.forename: Pradeep
authors.initials: P
authors.lastname: Pallati
authors.forename: Tommy
authors.initials: T
authors.lastname: Lee
authors.forename: Sumeet K
authors.initials: SK
authors.lastname: Mittal
mesh_terms: D000328:Adult; D000368:Aged; D001705:Bioprosthesis; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006551:Hernia, Hiatal / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013526:Surgical Mesh; D055815:Young Adult